Universal Health Coverage is integral to achieving the SDGs

Roger Paul Kamugasha, CNS Correspondent, UgandaIn December 2012 the UN passed a landmark resolution endorsing Universal Health Coverage (UHC) and the same is now at the forefront of the sustainable development goals (SDGs). Since then the World Health Organization (WHO) has identified UHC as a top priority for sustainable development and focusing on it as a tool to end TB in the sustainable development era generates a cocktail of strategies. UHC is ultimately a means to promote the human right to health. More than 100 low and middle income countries, home to almost 3/4 of the world’s population, have taken steps to deliver UHC.
The emerging economies of Brazil, Russia, India, China and South Africa representing almost half the world’s population are all at the forefront to have it work. However action on a much broader front is required to tackle the socio-economic determinants of health.

Critical enablers will include energizing political momentum towards UHC and ending TB. There is need for strong advocacy in low and middle income countries. Today about 40% of people with TB, 60% of children with TB and 80% of people with drug-resistant TB do not have access to appropriate treatment. It is a great opportunity for UHC efforts to prioritize these millions of underserved people who are missing from life-saving TB care.

Health Targets for SDG 3 are clear about achieving UHC that includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all, leaving no one behind.

Ending TB would mean 80% drop in new TB cases, 90% drop in people dying of TB, and 100% of TB affected families protected from catastrophic costs as indicated in the WHO End TB Strategy. These are ambitious, but feasible goals to end TB in the SDG era with integrated patient centred care, prevention, supportive health policies and systems and intensified research and innovation. All these need inter-sectoral collaboration and partnerships.

Multi sectoral collaboration was also the main focus of the Global Ministerial Conference: Ending TB in sustainable development era, organised by the WHO in Moscow during November 2017. It brought together more than 70 Ministers and other high level officials from many countries, along with representatives of development partners, private sectors NGOs, and CSOs to discuss a multi-sectoral response to end TB. This conference attached special emphasis to UHC and sustainable financing, aiming to ensure that every patient has access to care and treatment and is protected from financial hardships, as this protection is the cornerstone of UHC and sustainable development goals.

Innovation is a priority if we are to shift the paradigm in ending TB, as the Russian President Vladimir Putin mentioned in his conference opening remarks. Engaging leadership is pivotal to ending TB and rhymes well with the 2018 World TB Day theme of ‘Leaders for a TB- free World, you can make history. End TB’.

Tackling infectious diseases as a standalone may not yield universal multi-sector response. There is need for synergies across the responses to TB and non communicable diseases (NCDs). Accelerating progress towards UHC is essential to ensuring the health and wellbeing of all people. In Africa, it is estimated that 100 million people are forced into poverty annually due to the exorbitant costs of NCDs. Out of pocket payments for NCD treatment and care can constitute a major barrier to access and are often an important source of financial hardship and inequity

If the post 2015 development agenda is to be truly transformative for health, NCDs must be recognized as a priority and UHC must be articulated as a means to achieve improved health outcomes. Progress on NCDs relies on a balanced approach to prevention and treatment, with inexpensive population-based and clinical interventions simultaneously pursued. With limited resources in all our countries, UHC will become even more difficult unless more attention is given to prevention of illness and promotion of health.

To eliminate the stigma and discrimination experienced by people living with NCDs, communities and patient networks need to be empowered to claim their right to health, and hold their governments accountable for delivering UHC. As the HIV/AIDS response has highlighted, strengthening civil society is core to reducing inequities and improving access to treatment and care. Community-based approaches which have been particularly successful in mobilising demand for quality services for HIV/AIDS, should be drawn upon to support progress on UHC and NCDs.

The NCD epidemic poses challenges to financing functions, by imposing a huge economic burden on national and household budgets. At the national level, NCDs are contributing to extreme rises in direct medical costs which are draining health budgets. For low and middle income countries, the cumulative lost output associated with the four main NCDs is projected to exceed US$7 trillion between 2011 and 2025. This is roughly equivalent to $500 billion per year, or 4% of the Gross Domestic Product of LMICs. At the household level, people with NCDs are driven into chronic poverty by direct or out-of-pocket payments for health care costs.

As access to health services is influenced by social, cultural and economic determinants, efforts to reduce inequalities need to focus on the broader enabling environment. Comprehensive, multi-sectoral and ‘whole-of-society’ approaches are required, with action coordinated across a wide range of sectors and stakeholders. Policies, laws and regulations that improve opportunities and capabilities for economic productivity and social participation, and facilitate healthy lifestyles and environments are needed to complement the health system response.